![]() ![]() 1 The costs of cancer care vary considerably by cancer type and stage of treatment. As new cancer therapies become available that extend survival, and as the US population ages and continues to grow, the cost of cancer care is estimated to reach almost $158 billion in 2020, according to the National Cancer Institute. Īcquisition, analysis, or interpretation of data: Kim, Cai, Maniar, Kartika, haslam.ĭrafting of the manuscript: Kim, Cai, Kartika.Ĭritical revision of the manuscript for important intellectual content: Kim, Maniar, haslam, Prasad.Future research is needed to validate the algorithm for identifying conditioning regimens used with HSCT based on clinical data.Ĭancer is costly. No other disclosures were reported.Īuthor Contributions: Drs Kim and Prasad had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.Ĭoncept and design: Kim, Maniar, Prasad. doi: 10.1001/jamainternmed.2021.4826Ĭorresponding Author: Vinay Prasad, MD, MPH, University of California, San Francisco, 550 16th St, San Francisco, CA 94158 ( of Interest Disclosures: Dr Prasad reported grants from Arnold Ventures Research funding during the conduct of the study personal fees from Johns Hopkins Press Royalties, personal fees from Medscape Royalties, personal fees from MedPage Royalties, personal fees from UnitedHealthcare Consulting fees, personal fees from New Century Health Speaking fees, personal fees from Evicore Speaking fees, and personal fees from Patreon Plenary Session Podcast has Patreon backers outside the submitted work. Randomizing transplant-eligible patients at time of diagnosis with minimal restrictions on donor choice or induction regimens in both transplant and nontransplant cohorts would provide crucial information for informed decisions in patient care. Intermediate-risk acute myeloid leukemia is an example where retrospective studies are conflicting, and a pragmatic RCT is feasible. However, it would be more feasible to do pragmatic RCTs when there is clinical equipoise. The benefits of allogeneic transplantation are unknown in both highly lethal conditions such as plasma cell leukemia and less dismal conditions such as peripheral T-cell lymphoma. Instead, we aimed to provide an overview of the broad literature behind stem cell transplant. This study is limited as it is not a comprehensive review of evidence for specific disease types. ![]() These components should be explored formally in RCTs. Physicians may underestimate the burden of treatment and treatment complications and equate higher response rates or feasibility with longer survival or higher cure rates. However, offering an unproven aggressive therapy with high treatment-related mortality merely on the basis of poor predicted outcome is also questionable. Ethics and feasibility are raised regarding RCTs in this setting. Taken together, our results demonstrate that there has been widespread adoption of HCT, especially allogeneic transplant, based on low levels of evidence.Īllogeneic transplant has now become standard of care by historical precedent for hematologic malignant diseases with poor prognosis, such as high-risk acute myeloid leukemia. Yet of 103 ASTCT indications there were 70 S and C recommendations for allogeneic transplant and 41 for autologous transplant. In this review of the literature, we found that only 4 of 70 (6%) standard-of-care recommendations for allogeneic transplantation and 17 of 41 (41%) for autologous transplantation were supported by randomized clinical trials. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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